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HOLIDAY CVS, L.L.C.
STD339015 Healthy MD Clinical, LLC (f.k.a. Independent Medical Group, LLC)
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Covered Entity Details
Entity Name
Healthy MD Clinical, LLC (f.k.a. Independent Medical Group, LLC)
Subdivision Name
Fort Myers
Type
Sexually Transmitted Diseases
340B ID
STD339015
Entity Address
28420 Bonita Crossings Blvd
Ste 130
Bonita Springs, FL 34135
Grant Number
NH25PS004342-04-01
Participating Start Date
10/1/2020
Last Recertification Date
5/5/2025
Pharmacy Details
Pharmacy Name
HOLIDAY CVS, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 05787
11500 BONITA BEACH RD. SE
BONITA SPRINGS, FL 34135
Pharmacy Comments
Contract Details
Approval Date
7/14/2024
Contract Begin Date
8/12/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Steve Vixamar, COO
(954) 529-1178
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/14/2024
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